Comprehensive Head and Neck Exam

Fig. 1.1

Forehead and hairline (Photos courtesy of Anna Christine Napoli and Dr. Karin Schey)

Forehead and eyes

Palpate the forehead. Look for nodules, swellings, and masses (Fig.1.2).

Fig. 1.2

Palpation is a quick way to examine a patient for asymmetries

Cranial nerves and facial muscles

Have patient follow your fingers in an H pattern. Assess possible deficiency in facial nerve function (Fig.1.3).

Fig. 1.3

The patient should follow finger movements with the eyes, while not moving the head. Movement of the eye is controlled by the oculomotor, trochlear, and abducens nerves
Have patient squint, look for symmetry. Asymmetry during squinting could indicate facial muscle deficiency (Fig.1.4).

Fig. 1.4

Squinting may detect facial nerve symmetry (normal finding) or asymmetry (abnormal finding)

Ears

Inspect and palpate all visible portions of the ear (Fig.1.5).

Fig. 1.5

Outer ear
Look for color, pigmentation, contour, consistency, and function.

Eyes

Inspect the eyes (Fig.1.6).

Fig. 1.6

Check the eyes for sclera coloring, drainage, or swelling
Look for white sclera, absence of swelling, or drainage.
Yellow sclera may suggest jaundice.
Hematoma could indicate a bleeding disorder or injury.

Nose

Look up the nares (nostrils) and palpate the nose (Fig.1.7).

Fig. 1.7

Lack of symmetry of the nose should be noted when performing esthetic dental procedures as it may be critical when determining facial midlines
Look for nodules, swellings, and masses.

TMJ

Sitting or standing behind the patient, visually inspect the face. Look for symmetry in function. Note any abnormal deviation of the mandible.
Palpate the temporomandibular joint (TMJ) while having patient open and close with fingers placed over the condyles, bilaterally. Note clicking, popping, and discomfort/pain (Fig.1.8).

Fig. 1.8

If TMJ symptoms are present, a more extensive evaluation will be necessary
Look for nodules, swellings, and/or masses.

Parotid gland and preauricular nodes

Feel the parotid bilaterally and the preauricular nodes (Fig.1.9).

Fig. 1.9

Bilateral palpation of the parotid gland and preauricular area
Compare for symmetry, identify nodes by size and if they are hard or soft, painful or painless, and freely movable or fixed.
Possible findings: Lymph nodes may have nodules, swelling, and/or masses.

Posterior neck nodes

To palpate the posterior auricular and occipital nodes, drop head forward to enhance access to these areas.
Palpate over the trapezius muscle for the spinal accessory and posterior cervical nodes (Fig. 1.10a, b).

Fig. 1.10

(a, b) Tenderness to palpation should also be noted
Compare for symmetry and identify nodes for size, consistency (hard or soft), level of pain, or if freely movable or fixed.

Anterior neck nodes

Palpate the jugular chain, deep and superficial cervical nodes, by placing fingers firmly on both sides of the sternocleidomastoid muscle from its origin at the clavicle to its insertion at the mastoid process behind the ear (Fig. 1.11).

Fig. 1.11

Jugular lymph node enlargement along the sternocleidomastoid is common in patients experiencing the common cold or with head and neck cancer (Photo Courtesy of Dr. Eugenia Monaghan)
Palpate the supraclavicular, anterior scalene, and delphian nodes above the clavicles and near the inferior midline of the neck.
Compare for symmetry and identify nodes for size, consistency (hard or soft), level of pain, or if freely movable or fixed.

Thyroid gland and larynx

Visually inspect and bimanually palpate the thyroid. Compare both lobes for symmetry.
Normally, the thyroid gland is difficult to palpate.
Palpate the larynx while the patient swallows (Fig. 1.12).

Fig. 1.12

Inquire if patient has any difficulty swallowing
Inspect for enlargement or mobility. Listen for hoarseness.

Submandibular neck nodes

Tags: The Dental Reference Manual

Dec 11, 2016 | Posted by mrzezo in General Dentistry | Comments Off

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